An authorization is both a clinical and a financial record. If it is only a PDF in a folder, nobody sees it running out. This checklist reflects how we modeled it in NeuroOps.
In short: To track ABA authorizations, store each payer approval as a header with one line per CPT code, treat units as the source of truth (one unit is 15 minutes), model the lifecycle from draft to approved, denied or appealing, compute utilization from scheduled and completed events, alert 60 days before expiry, and audit every change.
1. One header, one line per CPT code
The header holds payer, period and status. Lines hold the approved units for 97151, 97152, 97153, 97155 and 97156 and so on, with a weekly cap where relevant.
2. Units, not hours, are the truth
One unit is 15 minutes. Derive hours as units divided by four.
3. Model the lifecycle
Draft, submitted, pended, approved, partially approved, denied, appealing and voided. Expired should be derived from the end date, not stored.
4. Reject approvals without approved hours
Recording an approval without approved hours per code should fail. Otherwise a client is enrolled with nothing to schedule against.
5. Compute utilization from events
Completed, scheduled and remaining units come from the calendar. Cancelled and no-show events do not count.
6. Alert before expiry
Warn at 60, 30, 14 and 7 days before the end date, and flag lines that are 90 percent used.
7. Connect denials to appeals
Store the denial reason and allow a denied authorization to move to appealing.
8. Start reauthorization early
Link the next authorization to the current one, and carry authorized and delivered units forward. See how ABA centers track reauthorization.
9. Encrypt and audit
Authorization numbers and notes are PHI. Encrypt them at the application layer and audit every read, write and override.
Frequently asked questions
What is an ABA authorization?
A payer approval for a number of therapy units per CPT code over a date range.
Which CPT codes are used in ABA?
97151 assessment, 97152 supporting assessment, 97153 direct therapy, 97155 supervision and 97156 parent training are common.
Learn more: ABA authorization management software.